{ "schemaVersion": 2, "eyebrow": "Pediatric Hospital Medicine", "title": "Bronchiolitis Oxygen and Admission Criteria", "summary": "Use respiratory effort, feeding safety, apnea history, risk factors, and persistent hypoxemia—not an isolated pulse-oximeter value—to determine disposition. For typical U.S. practice, initiate oxygen below 90%, reassess clinically after stabilization, and discontinue continuous monitoring once oxygen needs and work of breathing improve.", "seoDescription": "Evidence-based bronchiolitis admission, oxygen, monitoring, escalation, and discharge criteria for infants in emergency and inpatient care.", "clinicalQuestion": "Which infants with bronchiolitis require admission, supplemental oxygen, escalation of respiratory support, or safe discharge?", "specialty": "Pediatrics", "audience": "U.S. physicians and medical trainees", "tags": [ "bronchiolitis admission criteria", "bronchiolitis oxygen threshold", "SpO2 bronchiolitis", "pulse oximetry bronchiolitis", "infant respiratory distress", "bronchiolitis discharge criteria" ], "keyTakeaways": [ "Admit for severe respiratory distress, apnea or cyanosis, inability to maintain hydration, oxygen requirement to maintain saturation above 90%, high-risk host factors, or an unsafe home situation—not for a single borderline saturation alone. [24]", "AAP-aligned oxygen protocols use persistent SpO2 below 90% as the threshold to start supplemental oxygen and support discontinuing oxygen and saturation monitoring after clinical improvement. [9][10]", "For stabilized hospitalized infants managed to SpO2 90% or higher, intermittent pulse oximetry every 4 hours produces similar length of stay, safety, and clinical outcomes as continuous monitoring. [2]", "Do not use albuterol, epinephrine, or systemic corticosteroids routinely for typical bronchiolitis; bronchodilators do not improve meaningful outcomes and can cause tachycardia, tremor, and oxygen desaturation. [14][16]", "Persistent hypoxemia, rising work of breathing, apnea, fatigue, or failure of low-flow oxygen should prompt higher-acuity reassessment and consideration of high-flow nasal cannula or CPAP according to local capability. [12][18]" ], "sections": [ { "id": "initial-disposition", "eyebrow": "ED Decision", "heading": "Decide admission from respiratory trajectory, feeding, and risk", "intro": "Disposition should follow repeated clinical assessment rather than a pulse-oximeter value in isolation.", "paragraphs": [ "Admit an infant with severe respiratory distress—marked indrawing, grunting, or respiratory rate greater than 70/min—cyanosis or a history of apnea, dehydration or poor oral intake, or need for supplemental oxygen to maintain saturation above 90%. Admission is also appropriate when the family cannot safely provide care or return promptly if the infant worsens. [24]", "Lower the threshold for observation or admission in infants younger than 3 months, those born before 35 weeks' gestation, and those with hemodynamically significant cardiopulmonary disease or immunodeficiency. These factors identify patients at higher risk for severe disease even if the initial examination is not yet alarming. [24]", "At the bedside, observe a feed when feeding adequacy is uncertain. Coughing, sputtering, or increased respiratory difficulty during breast- or bottle-feeding supports admission for hydration support rather than outpatient management. Tachypnea above 60/min is another practical marker that feeding may be unsafe or unsustainable. [18][22]" ], "bullets": [ "Assess and document: room-air SpO2, respiratory rate and work of breathing, apnea/cyanosis history, oral intake and urine output, prematurity, age, cardiopulmonary or immune comorbidity, and caregiver ability to return for deterioration. [24]", "Escalate immediately for clinical fatigue or severe hypoxemia; endotracheal intubation and mechanical ventilation should be strongly considered in that setting. [18]" ], "subsections": [], "table": { "caption": "Disposition features that should alter the next level of care. [18][24]", "columns": [ "Clinical finding", "Interpretation", "Disposition action" ], "rows": [ [ "Indrawing, grunting, or RR >70/min", "Severe respiratory distress. [24]", "Admit; reassess frequently for fatigue or need for respiratory-support escalation. [18][24]" ], [ "Cyanosis or prior apnea", "Higher-risk presentation. [24]", "Hospital observation/admission; escalate promptly if recurrent apnea or respiratory fatigue develops. [18][24]" ], [ "Poor intake, dehydration, or feeding-associated cough/sputtering", "Hydration cannot be safely maintained orally. [18][24]", "Admit for enteral or parenteral fluid support. [21][22][24]" ], [ "SpO2 persistently <90%", "Meets AAP-aligned threshold for supplemental oxygen. [9][10]", "Provide oxygen and admit or continue monitored care based on respiratory status and response. [9][24]" ], [ "Age <3 months, prematurity <35 weeks, major cardiopulmonary disease, or immunodeficiency", "Increased risk of severe disease. [24]", "Use a lower threshold for observation or admission. [24]" ] ] } }, { "id": "oxygen-thresholds", "eyebrow": "Oxygen Management", "heading": "Use persistent hypoxemia, not transient desaturation, to guide oxygen", "intro": "Oxygen targets vary by guideline, but 90% is the principal U.S. management threshold in typical bronchiolitis.", "paragraphs": [ "For otherwise typical bronchiolitis, start supplemental oxygen when pulse oximetry shows SpO2 persistently below 90%; AAP-aligned protocols identify less than 90% as the threshold for oxygen initiation and advise stopping oxygen after improvement. U.S. clinical practice guidance cited in recent cohort work uses a target of 90% or greater while awake or asleep. [9][10]", "Do not prolong hospitalization for a clinically well infant solely because of small saturation fluctuations. Pulse oximetry has limited precision in the 76% to 90% range and a manufacturer-described margin of error of approximately plus or minus 2 percentage points; transient desaturations below 90% after discharge have been reported without an effect on readmission or clinical outcomes. [6][16]", "A higher oxygen threshold increases admission and length-of-stay pressure. Approximately one quarter of bronchiolitis hospitalizations in one study were prolonged by a perceived oxygen requirement after other discharge criteria were met, and practice changes using a 90% lower limit reduced oxygen use and length of stay without changing readmission rates. [1]" ], "bullets": [ "Interpret SpO2 alongside respiratory effort, perfusion, mental status, apnea, and feeding; a borderline reading without clinical compromise warrants reassessment rather than automatic admission. [1][6][16]", "An alternative threshold exists in non-U.S. guidance: NICE considers SpO2 below 92% alongside other referral, admission, oxygen, and discharge criteria, whereas recent Australasian guidance uses persistent SpO2 below 90% for infants at least 6 weeks old and below 92% for younger infants or those with underlying disease. [7][11][13]", "Document whether hypoxemia is persistent and whether it occurs on room air, during sleep, or during feeding; these details clarify whether oxygen is treating sustained gas-exchange impairment or an isolated monitor event. [1][9][10]" ], "subsections": [], "table": { "caption": "Oxygen thresholds and their intended clinical use. [7][9][10][11][13]", "columns": [ "Framework", "Threshold", "Clinical use" ], "rows": [ [ "AAP-aligned inpatient protocol", "SpO2 <90%. [9]", "Initiate supplemental oxygen; discontinue oxygen and saturation monitoring after improvement. [9]" ], [ "U.S. guideline target cited in multicenter cohort work", "SpO2 ≥90% awake or asleep. [10]", "Target used to guide oxygen, admission, escalation, and discharge decisions. [10]" ], [ "NICE", "SpO2 <92% considered with other criteria. [7]", "Use in referral, admission, oxygen, and discharge decisions; not a stand-alone disposition rule. [7][13]" ], [ "Australasian 2025 guidance", "Persistent SpO2 <90% at age ≥6 weeks; persistent SpO2 <92% if age <6 weeks or underlying condition. [11]", "Start oxygen at the applicable persistent hypoxemia threshold. [11]" ] ] } }, { "id": "monitoring-and-escalation", "eyebrow": "Inpatient Care", "heading": "De-escalate monitoring after stabilization and escalate for respiratory failure", "intro": "Monitoring intensity should track instability, not merely the presence of a bronchiolitis diagnosis.", "paragraphs": [ "Use continuous pulse oximetry during active instability, escalating oxygen need, or concern for apnea or respiratory failure. Once the infant is stabilized and managed to a saturation target of 90% or higher, transition to intermittent checks rather than maintaining continuous monitoring by default. In a six-center randomized trial of 229 hospitalized infants, intermittent oximetry every 4 hours and continuous oximetry had similar length of stay, medical interventions, safety, and parent-reported outcomes. [2]", "Failure of conventional oxygen support is a clinical escalation point, not simply a saturation number. Reassess for worsening retractions, tachypnea, apnea, poor feeding, fatigue, or persistent hypoxemia; high-flow nasal cannula and CPAP are the relevant noninvasive respiratory-support modalities evaluated for hospitalized hypoxemic bronchiolitis. [12][20]", "Secure hydration when oral feeding is inadequate. Hospitalized bronchiolitis care includes fluid therapy, and North American and Australasian guidance permits either nasogastric or intravenous routes; select the route according to respiratory effort, aspiration risk, enteral tolerance, and local practice. [21][22]" ], "bullets": [ "Stop continuous SpO2 monitoring after clinical improvement and oxygen discontinuation rather than using monitoring to detect isolated saturation dips that delay discharge. [1][9][16]", "If fatigue or severe hypoxemia develops despite support, obtain urgent critical-care assessment and consider invasive ventilation. [18]", "Avoid routine chest radiography and broad diagnostic testing in otherwise typical bronchiolitis; clinical assessment is the primary diagnostic and severity tool. [12][18]" ], "subsections": [], "table": { "caption": "Monitoring and support decisions after hospital admission. [2][9][12][18][21][22]", "columns": [ "Clinical state", "Monitoring and support", "Next decision" ], "rows": [ [ "Unstable work of breathing, active oxygen titration, apnea concern, or severe hypoxemia", "Continuous assessment and oxygen support; assess for respiratory failure. [18]", "Escalate level of care if fatigue, apnea, or hypoxemia persists. [12][18]" ], [ "Stabilized on a 90% or higher saturation target", "Intermittent pulse oximetry every 4 hours is reasonable. [2]", "Continue disposition assessment based on work of breathing and feeding. [2][24]" ], [ "Inadequate oral intake without shock", "Provide hydration by NG or IV route. [21][22]", "Reassess feeding tolerance and respiratory effort before discharge. [18][22]" ], [ "Clinical fatigue or severe hypoxemia", "Urgent respiratory and critical-care escalation; consider endotracheal intubation and mechanical ventilation. [18]", "Manage in a setting capable of advanced respiratory support. [18]" ] ] } }, { "id": "discharge-and-treatment-boundaries", "eyebrow": "Discharge Planning", "heading": "Discharge when oxygen, feeding, and caregiver safety criteria converge", "intro": "A room-air saturation alone is insufficient; discharge requires a stable clinical trajectory and feasible home observation.", "paragraphs": [ "Consider discharge when the infant no longer requires supplemental oxygen, has improving respiratory effort, and can maintain hydration by breast- or bottle-feeding or an established feeding plan. Confirm that caregivers can recognize deterioration, have the ability to return for care, and are not disadvantaged by excessive distance from the hospital or limited health literacy. [9][11][24]", "Do not restart or prolong oxygen solely for transient desaturation in an otherwise improving infant. The clinical consequence of a saturation threshold is substantial: modest differences in pulse-oximeter readings alter physician admission decisions, and unnecessary oxygen use can keep infants hospitalized after other discharge criteria are met. [1][6]", "Typical bronchiolitis remains supportive-care management. Do not routinely administer salbutamol/albuterol, epinephrine, or systemic corticosteroids; guideline-based recommendations advise against bronchodilators and epinephrine, and trials have not shown improved disease resolution, hospitalization, or length of stay with beta-agonists. Adverse effects include tachycardia, tremor, tachypnea, and oxygen desaturation. [14][16]" ], "bullets": [ "Before discharge, verify: no supplemental oxygen requirement, improving work of breathing, adequate fluid intake, and a caregiver plan for reassessment if apnea, cyanosis, worsening retractions, or feeding failure occurs. [9][11][24]", "Use home oxygen only within a structured home-care program with defined eligibility and follow-up; systematic-review data suggest feasibility in selected settings, but this is not a routine substitute for inpatient assessment of unstable infants. [17]", "If wheeze is accompanied by an atypical course or findings inconsistent with bronchiolitis, reassess the diagnosis rather than repeatedly trialing bronchodilators. [5][14]" ], "subsections": [], "table": { "caption": "Practical discharge checklist for bronchiolitis. [9][11][24]", "columns": [ "Domain", "Discharge-ready finding", "Barrier requiring continued observation or admission" ], "rows": [ [ "Oxygenation", "No ongoing supplemental oxygen requirement after improvement. [9]", "Persistent oxygen requirement or clinically significant hypoxemia. [9][24]" ], [ "Respiratory status", "Improving work of breathing without fatigue. [11][24]", "Severe distress, grunting, marked indrawing, apnea, cyanosis, or fatigue. [18][24]" ], [ "Hydration", "Adequate oral intake or sustainable feeding plan. [18][24]", "Dehydration, poor intake, or unsafe feeding because of respiratory effort. [18][24]" ], [ "Home safety", "Caregivers can monitor, understand return precautions, and return for care. [11][24]", "Family unable to cope, unreliable return access, or other home-safety limitation. [11][24]" ] ] } } ], "faq": [ { "question": "Should a sleeping infant with bronchiolitis be admitted for brief SpO2 dips below 90%?", "answer": "Not on that finding alone. Reassess signal quality and determine whether hypoxemia is persistent and accompanied by increased work of breathing, apnea, poor feeding, or other admission criteria. Transient desaturations are common and have not been associated with worse postdischarge outcomes, while overreliance on oximetry can prolong hospitalization. [1][6][16]" }, { "question": "When can continuous pulse oximetry be stopped in bronchiolitis?", "answer": "After the infant is clinically stabilized and managed to an SpO2 target of 90% or higher, intermittent monitoring every 4 hours is a reasonable alternative. A multicenter randomized trial found no difference in safety, interventions, or length of stay versus continuous monitoring. [2]" } ], "references": [ { "number": 1, "title": "Impact of Pulse Oximetry and Oxygen Therapy on Length of Stay in Bronchiolitis Hospitalizations", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamapediatrics/fullarticle/485734", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 2, "title": "Intermittent vs Continuous Pulse Oximetry in Hospitalized Infants With Stabilized Bronchiolitis: A Randomized", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamapediatrics/fullarticle/2776775", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 3, "title": "Critical care of severe bronchiolitis during shortage of ICU resources", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00029-4/fulltext", "authors": "www.thelancet.com", "host": "www.thelancet.com" }, { "number": 4, "title": "Systematic Review of Clinical Practice Guidelines for the Diagnosis ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/jid/article/222/Supplement_7/S672/5549996", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 5, "title": "The Problematic 2014 American Academy of... : Pediatric Emergency Care", "detail": "journals.lww.com", "url": "https://journals.lww.com/pec-online/fulltext/2019/09000/the_problematic_2014_american_academy_of.12.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 6, "title": "Oxygen in Acute Bronchiolitis - ScienceDirect.com", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1522840118300107", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 7, "title": "Evidence reviews for criteria for referral, admission, oxygen supplementation, and discharge - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK573296", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 8, "title": "The management of children with bronchiolitis in the Australasian hospital setting: development of a clinical practice guideline", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5809867", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 9, "title": "Implementing an Oxygen Supplementation and Monitoring Protocol on Inpatient Pediatric Bronchiolitis: An Exercise in Deimplementation - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5664324", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 10, "title": "Oxygen Saturation Targets in Infants Hospitalized With Bronchiolitis: A Multicenter Cohort Study | Hospital Pediatrics | American Academy of Pediatrics", "detail": "publications.aap.org", "url": "https://publications.aap.org/hospitalpediatrics/article/14/2/67/196366/Oxygen-Saturation-Targets-in-Infants-Hospitalized", "authors": "publications.aap.org", "host": "publications.aap.org" }, { "number": 11, "title": "Australasian Bronchiolitis Guideline: 2025 Update", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12397848", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 12, "title": "Prioritized PICO questions on the clinical management of bronchiolitis in infants and young children - WHO consolidated guidelines for the management of common childhood illness - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK622562", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 13, "title": "2019 surveillance of bronchiolitis in children: diagnosis and management (NICE guideline NG9) - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK573085", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 14, "title": "Bronchiolitis – Rationale for current recommendations for diagnosis and management", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7153727", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 15, "title": "The Diagnosis, Management, and Prevention of Bronchiolitis | Pediatric Clinical Practice Guidelines & Policies | AAP Books | American Academy of Pediatrics", "detail": "publications.aap.org", "url": "https://publications.aap.org/aapbooks/book/757/chapter/14094091/The-Diagnosis-Management-and-Prevention-of", "authors": "publications.aap.org", "host": "publications.aap.org" }, { "number": 16, "title": "Bronchiolitis – The Simple Things in Life…. | Hospital Pediatrics | American Academy of Pediatrics", "detail": "publications.aap.org", "url": "https://publications.aap.org/hospitalpediatrics/article/13/10/e314/193941/Bronchiolitis-The-Simple-Things-in-Life", "authors": "publications.aap.org", "host": "publications.aap.org" }, { "number": 17, "title": "Home Care for Bronchiolitis: A Systematic Review | Pediatrics | American Academy of Pediatrics", "detail": "publications.aap.org", "url": "https://publications.aap.org/pediatrics/article/150/4/e2022056603/189386/Home-Care-for-Bronchiolitis-A-Systematic-Review", "authors": "publications.aap.org", "host": "publications.aap.org" }, { "number": 18, "title": "Pediatric Bronchiolitis - StatPearls - NCBI Bookshelf - NIH", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK519506", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 19, "title": "Pulse Oximetry Interpretation FAQ | ACEP", "detail": "acep.org", "url": "https://acep.org/administration/reimbursement/reimbursement-faqs/pulse-oximetry-interpretation-faq", "authors": "acep.org", "host": "acep.org" }, { "number": 20, "title": "High‐flow nasal cannula therapy for infants with bronchiolitis - Armarego, M - 2024 | Cochrane Library", "detail": "www.cochranelibrary.com", "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009609.pub3/references", "authors": "www.cochranelibrary.com", "host": "www.cochranelibrary.com" }, { "number": 21, "title": "Parenteral versus enteral fluid therapy for children hospitalised with ...", "detail": "www.cochranelibrary.com", "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013552.pub2/pdf/full", "authors": "www.cochranelibrary.com", "host": "www.cochranelibrary.com" }, { "number": 22, "title": "Parenteral versus enteral fluid therapy for children hospitalised with bronchiolitis - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8635777", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 23, "title": "Impact of a modification of the clinical practice guide of the American Academy of Pediatrics in the management of severe acute bronchiolitis in a pediatric intensive care unit - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7170801", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 24, "title": "Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC4235450", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Impact of Pulse Oximetry and Oxygen Therapy on Length of Stay in Bronchiolitis Hospitalizations", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamapediatrics/fullarticle/485734", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "Impact of Pulse Oximetry and Oxygen Therapy on Length of Stay in Bronchiolitis Hospitalizations. Impact of Pulse Oximetry and Oxygen Therapy on Length of Stay in Bronchiolitis Hospitalizations. **Objective**To determine the extent to which bronchiolitis hospitalizations are prolonged by a perceived ", "score": 0.7286136 }, { "number": 2, "title": "Intermittent vs Continuous Pulse Oximetry in Hospitalized Infants With Stabilized Bronchiolitis: A Randomized", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamapediatrics/fullarticle/2776775", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "**Findings**In this multicenter randomized clinical trial of 229 infants hospitalized with stabilized bronchiolitis with and without supplemental oxygen and with care managed using an oxygen saturation target of 90% or higher, length of hospital stay, medical interventions, safety, and parent-report", "score": 0.6638657 }, { "number": 3, "title": "Critical care of severe bronchiolitis during shortage of ICU resources", "detail": "www.thelancet.com", "url": "https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00029-4/fulltext", "authors": "www.thelancet.com", "host": "www.thelancet.com", "snippet": "High-flow nasal cannula therapy: can it be recommended as initial or rescue care for infants with moderate bronchiolitis in the paediatric ward?", "score": 0.63316137 }, { "number": 4, "title": "Systematic Review of Clinical Practice Guidelines for the Diagnosis ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/jid/article/222/Supplement_7/S672/5549996", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Bronchiolitis is the leading cause of hospital admission for respiratory disease among infants aged <1 year. Clinical practice guidelines can benefit patients", "score": 0.74161834 }, { "number": 5, "title": "The Problematic 2014 American Academy of... : Pediatric Emergency Care", "detail": "journals.lww.com", "url": "https://journals.lww.com/pec-online/fulltext/2019/09000/the_problematic_2014_american_academy_of.12.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "The 2014 American Academy of Pediatrics bronchiolitis guidelines do not adequately serve the needs and clinical realities of front-line clinicians caring for undifferentiated wheezing infants and children. This article describes the clinical challenges of evaluating and managing a heterogeneous dise", "score": 0.61196244 }, { "number": 6, "title": "Oxygen in Acute Bronchiolitis - ScienceDirect.com", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S1522840118300107", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Pulse Oximetry Utilization and Influence on Admission Rates and LOS Pulse oximetry is frequently used as the fifth vital sign in assessment of patients with respiratory complaints, with small changes in SpO 2 driving medical decision making despite a well-known lack of precision in the 76-90% range ", "score": 0.65412235 }, { "number": 7, "title": "Evidence reviews for criteria for referral, admission, oxygen supplementation, and discharge - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK573296", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "#### 1.1.1. Introduction\n\nBronchiolitis is a lower respiratory tract infection most reported in babies under the age of one. Symptoms are similar to those of the common cold but can be associated with serious outcomes. Therefore, identifying babies and children who are experiencing, or are likely to", "score": 0.81875163 }, { "number": 8, "title": "The management of children with bronchiolitis in the Australasian hospital setting: development of a clinical practice guideline", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5809867", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "A systematic literature search for all 33 questions was undertaken. The search strategy inclusion criteria included:Population: infants under 24 months of age with bronchiolitis.Interventions: diagnostic tests and investigations, oxygen therapies, medications, rehydration, scoring systems and others", "score": 0.7827459 }, { "number": 9, "title": "Implementing an Oxygen Supplementation and Monitoring Protocol on Inpatient Pediatric Bronchiolitis: An Exercise in Deimplementation - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5664324", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Hypoxemia requiring supplemental oxygen (O2) is a key determinant in the decision to hospitalize infants with bronchiolitis and contributes to increased length of stay (LOS) . Updated clinical practice guidelines released by the American Academy of Pediatrics (AAP) in 2014 identify O2 supplementatio", "score": 0.75809944 }, { "number": 10, "title": "Oxygen Saturation Targets in Infants Hospitalized With Bronchiolitis: A Multicenter Cohort Study | Hospital Pediatrics | American Academy of Pediatrics", "detail": "publications.aap.org", "url": "https://publications.aap.org/hospitalpediatrics/article/14/2/67/196366/Oxygen-Saturation-Targets-in-Infants-Hospitalized", "authors": "publications.aap.org", "host": "publications.aap.org", "snippet": "Clinical practice guidelines recommend managing infants with bronchiolitis using an oxygen saturation target of 90% while the infant is awake or asleep.9,10 The choice of oxygen saturation target is important because it influences clinician decisions on hospital admission, supplemental oxygen use, e", "score": 0.7295395 }, { "number": 11, "title": "Australasian Bronchiolitis Guideline: 2025 Update", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12397848", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "| Saturation targets | 12b | ✓ | In the 2025 update, it is recommended to use supplemental oxygen in infants with bronchiolitis if SpO 2 is persistently < 90% in infants aged ≥ 6 weeks. For infants < 6 weeks of age, or < 12 months of age with an underlying health condition, supplemental oxygen shoul", "score": 0.7230167 }, { "number": 12, "title": "Prioritized PICO questions on the clinical management of bronchiolitis in infants and young children - WHO consolidated guidelines for the management of common childhood illness - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK622562", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "4. In infants and children aged less than 2 years hospitalized with acute bronchiolitis and hypoxaemia, does administration of supplemental oxygen through nasal bubble continuous positive airway pressure (CPAP) rather than standard flow oxygen through nasal prongs/face mask/headbox oxygen improve cl", "score": 0.7230167 }, { "number": 13, "title": "2019 surveillance of bronchiolitis in children: diagnosis and management (NICE guideline NG9) - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK573085", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "No new evidence was identified through this surveillance review to suggest that a child could not be referred for emergency care and remain safe if their oxygen levels were lower than 92%, or that a child does not need oxygen supplementation if their levels are above 90%. Therefore, no impact on the", "score": 0.7023877 }, { "number": 14, "title": "Bronchiolitis – Rationale for current recommendations for diagnosis and management", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7153727", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "There has been a perception since a long time that bronchiolitis required the use of bronchodilators in order to improve the oxygen saturation and decrease the respiratory distress associated with the illness. According to the current guidelines, there is a strong recommendation that bronchodilators", "score": 0.6932451 }, { "number": 15, "title": "The Diagnosis, Management, and Prevention of Bronchiolitis | Pediatric Clinical Practice Guidelines & Policies | AAP Books | American Academy of Pediatrics", "detail": "publications.aap.org", "url": "https://publications.aap.org/aapbooks/book/757/chapter/14094091/The-Diagnosis-Management-and-Prevention-of", "authors": "publications.aap.org", "host": "publications.aap.org", "snippet": "Title: The Diagnosis, Management, and Prevention of Bronchiolitis | Pediatric Clinical Practice Guidelines & Policies | AAP Books | American Academy of Pediatrics\nBook cover for Pediatric Clinical Practice Guidelines & Policies (24th Edition). Pediatric Clinical Practice Guidelines & Policies. S", "score": 0.6737291 }, { "number": 16, "title": "Bronchiolitis – The Simple Things in Life…. | Hospital Pediatrics | American Academy of Pediatrics", "detail": "publications.aap.org", "url": "https://publications.aap.org/hospitalpediatrics/article/13/10/e314/193941/Bronchiolitis-The-Simple-Things-in-Life", "authors": "publications.aap.org", "host": "publications.aap.org", "snippet": "Title: Bronchiolitis – The Simple Things in Life…. | Hospital Pediatrics | American Academy of Pediatrics\nAlthough bronchiolitis presents similarly to asthma, bronchodilators have not been demonstrated to improve any clinically meaningful outcomes, such as duration of hospital admission or oxygen sa", "score": 0.6578248 }, { "number": 17, "title": "Home Care for Bronchiolitis: A Systematic Review | Pediatrics | American Academy of Pediatrics", "detail": "publications.aap.org", "url": "https://publications.aap.org/pediatrics/article/150/4/e2022056603/189386/Home-Care-for-Bronchiolitis-A-Systematic-Review", "authors": "publications.aap.org", "host": "publications.aap.org", "snippet": "Title: Home Care for Bronchiolitis: A Systematic Review | Pediatrics | American Academy of Pediatrics\nStudies from Colorado (*n* = 4) discharged patients directly from the emergency department, whereas studies from Utah (*n* = 3) used an observational unit (OU)–HOT protocol.21–23,25–28 The OU was a ", "score": 0.6271529 }, { "number": 18, "title": "Pediatric Bronchiolitis - StatPearls - NCBI Bookshelf - NIH", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK519506", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Infants with tachypnea exceeding 60 breaths per minute or oxygen saturation levels below 92% should be considered for hospitalization and supplemental oxygen. Patients with severe respiratory compromise may benefit from a trial of aerosolized albuterol.(#article-26822.r16) In cases of clinical fatig", "score": 0.62248284 }, { "number": 19, "title": "Pulse Oximetry Interpretation FAQ | ACEP", "detail": "acep.org", "url": "https://acep.org/administration/reimbursement/reimbursement-faqs/pulse-oximetry-interpretation-faq", "authors": "acep.org", "host": "acep.org", "snippet": "The 2023 E/M guidelines specifically state the pulse ox cannot be used when calculating the data element of the MDM (“For the purposes of data reviewed and analyzed, pulse oximetry is not a test.”). It may be reasonable to take pulse ox interpretation into account when considering the Nature and Co", "score": 0.51866865 }, { "number": 20, "title": "High‐flow nasal cannula therapy for infants with bronchiolitis - Armarego, M - 2024 | Cochrane Library", "detail": "www.cochranelibrary.com", "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009609.pub3/references", "authors": "www.cochranelibrary.com", "host": "www.cochranelibrary.com", "snippet": "| Participants | Infants with a clinical diagnosis of bronchiolitis admitted to Bristol Children's Hospital Department of Paediatric Respiratory Medicine Recruited: 21 infants (1 excluded with onset of apnoea, 1 excluded with fall in oxygen requirement) Randomised: 19 infants, median age 3.0 month", "score": 0.6002124 }, { "number": 21, "title": "Parenteral versus enteral fluid therapy for children hospitalised with ...", "detail": "www.cochranelibrary.com", "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013552.pub2/pdf/full", "authors": "www.cochranelibrary.com", "host": "www.cochranelibrary.com", "snippet": "The main focus of treatment for children hospitalised with bronchiolitis is supportive, including oxygen supplementation, respiratory support, and fluid therapy", "score": 0.24021314 }, { "number": 22, "title": "Parenteral versus enteral fluid therapy for children hospitalised with bronchiolitis - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC8635777", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Inclusion criteria were infants admitted with a clinical diagnosis of bronchiolitis (symptoms and signs of respiratory distress (tachypnoea, recessions, nasal flaring, or cyanosis) associated with symptoms of a viral respiratory tract infection) aged between 8 weeks (corrected for prematurity) and 1", "score": 0.6897452 }, { "number": 23, "title": "Impact of a modification of the clinical practice guide of the American Academy of Pediatrics in the management of severe acute bronchiolitis in a pediatric intensive care unit - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7170801", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "According to the reviewed literature, and in consistency with our own results, 2–3% of all patients with bronchiolitis require hospital admission, and of these, 3–11% must be admitted to the PICU.9, 10\n\nRespiratory syncytial virus remains the leading cause of bronchiolitis, as evidenced by all the p", "score": 0.64986813 }, { "number": 24, "title": "Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC4235450", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "### TABLE 4.\n\nGroups at higher risk for severe disease\n\n| |\n\n| Infants born prematurely (<35 weeks’ gestation) |\n| <3 months of age at presentation |\n| Hemodynamically significant cardiopulmonary disease |\n| Immunodeficiency |\n\n### TABLE 5.\n\nGuidelines for admission may include\n\n| |\n\n| Signs of se", "score": 0.6133529 } ], "publishedAt": "2026-09-15T21:33:21.524870+00:00", "updatedAt": "2026-09-15T21:33:21.524870+00:00", "readingMinutes": 5, "slug": "bronchiolitis-oxygen-and-admission-criteria" }